Archive for the ‘Hospital’ category

COVID VACCINE CHALLENGE

September 23rd, 2020

COVID vaccine challenge
NICK JACOBS
Published Tue Sep 22, 2020 8:48 PM EDT

Besides wearing a mask, which we’ve known since 77AD protects us from the plague, the other best opportunity for stopping the progress of COVID-19 is through the discovery of an effective vaccine.

Rather than getting COVID via the natural infection pathway, a vaccine could produce herd immunity without harming or potentially killing people.

Thousands of Americans seem to have chosen the risk-it-all route as they go without masks, and attend large, unprotected social events and rallies.

Unfortunately, not unlike playing Russian Roulette with your loved ones and friends, this route is filled with potential suffering and an almost complete lack of predictability.

In an article in Time magazine, Alice Parks recounts how it was Edward Jenner who, in 1790, discovered that infecting people with small amounts of smallpox virus could produce immunity. Today, there are more than 100 vaccines being developed in an attempt to provide us with immunity from SARS COVID-19, and across the world, billions of dollars are being pumped into this effort.

There are numerous challenges to be faced in this effort including those of manufacturing and then distributing the vaccine in a humanitarian manner.

The good news is, regardless of political pressure, the major vaccine makers have already pledged to conduct complete safety studies before submitting their vaccines to international regulators. The not-so-good news is HIV/AIDS has been around for nearly 40 years and an effective vaccine is still not available.

Approximately 132,000,000 people in the United States are living with pre-existing health conditions. Thus, the challenge becomes who gets a vaccine and when. These decisions may literally produce a life and death lottery game.

The Time article cited researchers from CUNY’s School of Public Health’s computer simulation that calculated if 75 percent of the world’s population were immunized, to control the ongoing pandemic, vaccines would need to be about 70 percent effective. Any of us who are regular recipients of the annual flu vaccine know that some years it’s effective and some years it’s not.

Consequently, we will be faced with arguments over the world’s current state of nationalism combined with America’s anti-vaccination movement. Plus we still have the challenges of discovery, manufacturing and actual implementation.

Oh, and there’s one more speed bump in that the United States has chosen not to join the other 172 countries of the world in the COVAX initiative on international unity for epidemic preparedness innovations originated by the World Health Organization.

If we prioritize our high-risk populations which include health care employees, first-responders, people with pre-existing conditions, and the elderly living in group environments, and then add critical workers such as teachers, food growers and service providers, people in group homes and the incarcerated, we finally end up getting the vaccines to our most precious hope for the future, young adults and children.

In short, none of this is going to be easy. One batch of improperly manufactured polio vaccine in the 1950s resulted in thousands of children being accidentally infected with polio. and because there are so many variations of vaccines being developed, there is also the risk of triggering excessive immune responses that could end up being more harmful than helpful.

Finally, and this is one more example of the broken public health system in this country, any plans for massive immunizations will be dependent upon public-health initiatives that are appropriately supported and resourced.

Keep in mind many of our states have been seeking leadership, supplies, direction, and funding from the federal government since March. At about $35 per dose and in most cases the vaccines require two doses, herd immunity is not likely to be achieved either quickly or in a cost-effective manner.

One thing is clear, however. An effective plan needs to be implemented to stop this out of control COVID transmission and to produce a clear pathway to normalcy. We need to get back to normal through a national strategy.

 

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Acupuncture why not

February 19th, 2020

 

Accupuncture, why not?

NICK JACOBS

Published Tue Feb 18, 2020 8:15 PM EST

In a recent article in Time Magazine, Jeffrey Kluger wrote “The Mystery of Acupuncture.”

In the article he said the “World Health Organization has declared acupuncture a useful adjunct for more than 50 medical conditions, including chronic stress.” He went on to write that the NIH (National Institute of Health) also agrees and has endorsed acupuncture as a potential treatment for migraines, menstrual cramps, abdominal pain, tennis elbow, and nausea resulting from chemotherapy and more. “The fact the Mayo and Cleveland Clinics have embraced acupuncture and groups like the AMA have gotten states to designate acupuncture as an essential health benefit is more than significant.”

Kluger went on to say that more than 3.5 million adults and 80,000 children use acupuncture in the U.S annually. The military is using it for PTSD, pain disruption, and an assortment of ailments not the least of which is lower back pain. With all this information and these overwhelming statistics, why aren’t more of us using acupuncture?

If it’s fear of needles, you’re uninformed. These needles couldn’t be any smaller and less noticeable. As stated in the article, “The analgesic impact of a tiny needle is more than worth it.” The real beauty of this ancient Chinese practice is even if the practitioner doesn’t do it perfectly, it can’t hurt you.

Probably the most powerful potential use for acupuncture is in the treatment of addiction. Considering that more than 50 million Americans suffer from chronic pain, acupuncture as a treatment for chronic pain is one possible alternative to OxyContin and other addictive pain drugs. Of course, spinal manipulation by a physician trained in osteopathic medicine, a DO, or a chiropractor, plus yoga, and potentially non-addictive cannabinoids are also being used.

There have been more than 19,000 papers written about the efficacy of acupuncture, and recently I saw statistics on back surgery that were less than encouraging. According to recent studies, back surgeries are sometimes as low as 30% effective. Moreover, having been personally a regular sufferer from back pain, osteopathic manipulation, exercise, weight loss, and acupuncture have all been medical gifts that have worked beautifully for me over the years.

The question then becomes, why not? Why aren’t you trying acupuncture? Is it because you don’t understand how it works? Is it because some medical professional has indicated it is “woo-woo medicine?” Or is it because you’re afraid of the tiny little needles?

Maybe it is because you’re concerned it might be harmful in some manner? If you could be assured all these are really non-issues, what else would prevent you from trying this?

I’ve often quoted the book “Change or Die” which examines the thesis that many of us would rather die than change. I’m sure this idea sounds incomprehensible to many of you, but think about it. We are inundated every day with advertising, political narratives, and scientific treatises sponsored by organizations, businesses and associations that want us to remain loyal to their financial interests.

I’ll never forget the conversation I had with a scientist who once told me that hydrogenated fats were the biggest medical experiment perpetuated on mankind without our knowledge. It prolonged the life of food on the shelves while killing half a million Americans each year from inflammatory disease.

Industrial farms, Big Pharma, the soft drink and snack food industry all have their stakes firmly planted in the ground, or more specifically in our brains, with millions or billions of dollars of advertising to indoctrinate us over the years.

One of Jerry Seinfeld’s routines talked about food from his era, including boxes of chocolate chip-filled mini cookies that were sold as cereal.

We Boomers all remember hydrogenated margarine that sat on the table all day without refrigeration, those wonderful Twinkies, and, of course, physicians who were featured in ads endorsing the health benefits of cigarettes.

Try acupuncture. It really can’t hurt you.

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Pittsburgh Post Gazette. Op-Ed

December 11th, 2017

Nick Jacobs, among his other affiliations, is an officer of the Integrative Health Policy Consortium, which represents more than 600,000 IHM practitioners; president of the Clinical and Translational Genome Research Institute, which he founded; and a consultant to the Department of Defense in breast cancer research.

Pennsylvanians received good news recently when the Pennsylvania Health Care Cost Containment Council reported that hospital readmissions and mortality rates continue falling locally and statewide.

The report shows these rates declining for a number of common types of treatments. It gives much of the credit to a “commitment of PA hospitals to provide quality care” and to the Affordable Care Act, which ties reimbursements to that quality care. This, in turn, encourages health care facilities to strive for improved mortality rates because doing so helps keep government funds flowing through their doors.

Regardless of the motivation, this is good news. But it’s not good enough.The mortality rate could be improved even more dramatically if more healthcare administrators and physicians would introduce integrative health and medicine practices into their services.

Integrative health and medicine (IHM), as defined by the American Board of Integrative Medicine and the Academic Consortium for Integrative Medicine & Health, recognizes the importance of the relationship between practitioner and patient. IHM focuses on the whole person, is evidenced-based and employs a wide range of appropriate therapies, healthcare professionals and disciplines to achieve optimal health and healing.

Integrative health practice includes treatments and therapies such as acupuncture; natural products; deep breathing; Tai chi and Qi Gong; meditation; massage; special anti-inflammatory diets; progressive relaxation; journaling; biofeedback; pet, music and dance therapies; hypnosis and guided imagery. When provided by a licensed or certified health care professional, IHM provides numerous benefits. It can decrease chronic pain, post-operative pain and the need for medications. It can improve patient satisfaction and shorten hospital stays. It can lower mortality rates. IHM methods also are relatively inexpensive.

Many places, including the Cleveland Clinic, have reported cost savings per patient, while also seeing reductions in patient anxiety, pain, and medications. During my tenure as CEO at Windber (Pa.) Medical Center, I worked with physicians, staff, and volunteers to create a healing environment by embracing all methods and therapies used in integrative medicine and combining them with the ambiance of a fine hotel and the amenities of a health spa. We carefully scrutinized and credentialed practitioners specializing in services such as aroma and massage therapy, integrative nutritional counseling, acupuncture, chiropractic manipulation, pet and music therapy, reiki and spirituality, to name a few.

In short, a healing environment permeated our facility.

Yes, we had our share of naysayers and opposition among physicians, allied health care professionals and others, but over time our infection rate dropped below 1 percent and stayed there for a decade. (The national average is 9 percent.) Of our peer hospitals, we had the lowest readmission rates, restraint rates and lengths of stay. Even with a palliative care unit to care for dying patients and their families, we had the lowest death rate among our peer hospitals.

For those who would say it was all coincidence because Windber is a small hospital, I would direct them to the 19,000 papers written supporting the efficacy of acupuncture alone, and then to the thousands of papers written about the healing power of music, massage and so many other treatments dismissed all too readily by traditional practitioners.

IHM practices are not at odds with traditional medical practices; rather, they enhance them. Yet in many hospitals and physicians’ offices, they are ignored, discouraged, even ridiculed. Such negative reactions result from ignorance, misinformation, prejudice and even greed — pharmaceutical companies, for instance, see no profit in promoting most IHM treatments, and some medical practices might earn less if, instead of scheduling patients for costly treatments or surgeries, they instead treated patients with acupuncture, spinal manipulation, massage therapy or even mindfulness.

Resistance to IHM is breaking down, but this shift in attitude needs to be accelerated. If you travel to Europe or Asia, you will see integrative medicine practices thriving because their value is acknowledged and embraced. In America, IHM beachheads are being established in health care systems and universities, thanks to such groups as the Family Medicine Education Consortium, Integrative Health Policy Consortium and the Academy of Integrative Health and Medicine, of which I am a co-founder. The academy includes among its member’s hundreds of licensed physicians who have successfully merged IHM with traditional medical practices.

Much remains to be done to more broadly spread the healing benefits of IHM, which will happen only when more patients take more responsibility for their health and demand IHM treatments, more physicians research and adopt them, and more insurance companies pay for them. When that day comes, there will be a lot more good news about mortality rates and other measures of medical care for Pennsylvanians and people all over the country to celebrate.

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Four ways to improve access to Integrative Medicine Practices

November 13th, 2017

Licensure, regulation, medical evidence, and funding are four sure ways to speed up the process needed to allow integrative medicine practices to be embraced. If we begin with the assumption that money has a lot to do with everything medical in the United States, then we must look at the winners and losers and the WIFM’s?  (What’s in it for me?)  If you’re a practicing surgeon, and acupuncture or chiropractic care results in the patient not needing a surgery, that can be a financial threat to you. Let’s be fair, that probably doesn’t happen that often, but sometimes it does, and when it does, that’s money lost to your practice.

 

If you’ve spent four years in undergraduate school, four years in medical school, four or five years in a residency, and your educational debts amount to hundreds of thousands of dollars, the last thing you need is a clinical study demonstrating through medical evidence that thousands of patients won’t need your services, and your skills will become exponentially less in the demand.

 

On the other hand, if, like ophthalmologists who surround their practices with optometrists, orthopods did the same with chiropractors and acupuncturists, could that not create a steady stream of referrals for their practices?

 

Let’s face it, there is a role for all three of those professions, and there are skill levels in every profession and duties relegated to each that both overlap and potentially conflict. So, wouldn’t it be better to have the three practice as a team of professionals working together to help you?

 

“There’s not enough medical evidence”  has been the hue and cry of the uninformed for years. Ironically, once traditional medical evidence is thoroughly interrogated, it’s not unusual to find numerous flaws in even the most accepted medical practices. We’ve seen slanted reporting in even the furthermost prestigious journals where various drugs, procedures, and devices have been proven to be ineffective years later.

 

There are over 19,000 papers that have been written and submitted to medical journals in which acupuncture has been endorsed and proven to be effective, but there never seems to be enough medical evidence for the naysayers.

 

Credentialing is a very challenging area as well.  Not unlike the highly skilled surgeon with her medical degrees from the Sorbonne in Paris that is not permitted to practice medicine in the United States, there are sometimes economic and political reasons to limit the number of practitioners allowed in the United States. In my experience, by creating a hospital-based credentials committee that specializes in integrative medicine, the nay-sayers ability to discredit highly trained practitioners with different skills will become more limited.

 

Regulation may be the most difficult challenge in this discussion because, as we have come to know very well, political power can come from political contributions, and when it comes to regulations, those with the gold have more clout than those without. That is not to say that our politicians can be encouraged to be more flexible because they can.  All it takes is for hundreds of constituents to stand in front of a Congressional office to encourage change to occur.

 

So, what are we really dealing with here?  In 1910, the AMA put out a request for proposal to determine what should be taught in the medical schools of Canada and the United States and no physician would accept that assignment.  Consequently, a Ph.D., Abraham Flexner, did, and his approach was to eliminate everything that wasn’t already proven science.  From there we have evolved to a “heal to the pill” mentality where words like root cause and placebo have been dropped from the vernacular.

 

Finally, funding is the key. It has been proven time and again that integrative medicine practices can reduce health care costs exponentially. With that in mind, every bill that comes out of Washington ignores that fact, and funding for many of these well-documented practices is not present. There were over 5000 codes in the Affordable Care Act that were intended to fund such practices as acupuncture, but when the FAQ initially was released, it said, in essence, “Don’t worry about paying these codes.”

 

If you go almost anywhere in Europe and Asia and you will see integrative practitioners thriving because their value is acknowledged and embraced. Of course, we’re not professing that a massage therapist performs open heart surgery, but we do know that Integrative medicine can help to reduce costs across the board.

 

There are many good things that can come from Integrative medicine. You just need to be open-minded.

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Memories of a new puppy and Pet Therapy

December 14th, 2016

It was a brisk, early, spring, weekend morning and Joanna, then a 16-year-old, now mother of four, said that we needed a transition dog. Tessie, our part-golden, part-black lab, part-border collie was getting long in the tooth, and it was our custom to always bring a replacement puppy into the house when the older dog was beginning to head toward the rainbow bridge.

So, at Jo’s insistence, we drove to a dog pound about 23 miles away. When we got there, it was closed, but she kept pushing hard for a new puppy.

We then headed for another sanctuary for abandoned dogs, a no kill shelter. That shelter was about 31 miles in the other direction. We arrived right before closing time and were directed to a room that was filled with a half dozen beautiful, little, white puppies.

The puppy that jumped the highest and yipped the most was not our choice. It was instead it’s little brother, the most loving and cuddly of the brood. The volunteer said that he was probably part sheep dog and part poodle, but we really didn’t care what he was because he was adorable.

We paid our fee, packed him up, jumped into the car and headed home to our older dog Tessie for what would become months of mothering, teaching and unconditional love and patience. Jo named him Brody, and it fit him perfectly.

Tessie taught him how and when to go to he bathroom and, she taught him to be terrified of thunder, to bark at the meter readers, to play with the cats as if they were his very best friends, and to beg from me at the table. While Brody reminded Tessie how to play, he became her adopted puppy.

One evening, a newly roasted turkey was placed on the stove to cool. While working on my computer, I heard some noise in the kitchen. The next thing I heard was puppy feet on the steps and then a thump, puppy feet and a thump, puppy feet and a thump. Then Brody, the puppy appeared at my chair, his belly was completely distended, and he smelled of turkey breath. He and Tessie had eaten the entire thing. Kind of like the Butkus dogs on “A Christmas Story.”

Well, Brody grew to be the best dog and best friend ever. In fact, when my mother visited, she would hold complete conversations with him as if he was a human being.

In her obituary I wrote that “She often scolded her sons for not talking enough to their animals.” Somehow the Pittsburgh newspaper accidentally changed that line to “She often scalded her sons for not talking enough to their animals.” Only those who knew my mom could have ever appreciated the absurdity of that printed mistake. So, when people said they were sorry and scanned my body for burn scars, I knew why.

It was about six years after he joined us that I went on a heart healthy diet that excluded all meat, and, since I was the only sucker in the family who would sneak him table scraps, he had to follow my diet. He became a vegetarian dog. In fact, with some of the new fat free products and make believe meats, I always made it a rulethat if Brody wouldn’t eat it, I wouldn’t eat it either. That diet extended both of our lives.

After Brody died my life became doggy less, and I’ve never gotten over that disconnect, but with my schedule and all of the traveling that I do, it would not be fair to either the dog or to me.

So, I always spend considerable petting time with my daughter’s dog, Chipper, and believe me when I tell you that when I’m around, he is completely spoiled in every way because I’m just a dog kinda guy.

And in Tessie’s memory I added pet therapy at the hospital while I was a CEO, and I’m still convinced that those dogs provided as much healing as many of the drugs.

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The Alpha and Omega of Healthcare in the United States

August 27th, 2011

While serving as a hospital administrator for over twenty years, I was aware of numerous people who had died in the emergency room because they had no insurance, had not yet qualified for Medicaid and were terrified that the cost of care would force them to live on the street.  Consequently, they waited too long to come in for treatment, and they died.

Rep. Paul Ryan (R-W) and Gov. Peter Shumlin (D-VT) - Nick Jacobs, FACHE - Healing HospitalsModern Healthcare’s August 22nd edition has listed the 100 Most Influential People in Healthcare in 2011. (Somehow they’ve missed me again.)  They’ve listed Republican  Congressman Paul Ryan of Wisconsin as the number one most influential person, and the Democratic Governor of Vermont, Peter Shumlin, as number two. Ryan is interested in a complete re-make of the Medicare and Medicaid programs, and Shumlin wants to move the citizens of the State of Vermont to a government-run, single-payer system.

Needless to say, these are very different views. It’s interesting that they both agree that employer-based insurance should be eliminated, so that neither portability nor employment is an issue. They differ in that Ryan believes that each individual citizen should receive a refundable tax credit for healthcare and that providers should compete based upon quality, price and outcomes. Shumlin, on the other hand, wants to do away with “fee for service healthcare,” but clearly understands the American’s public’s concern about government-run anything, and even says, “Government has gotten it wrong, every single time.”

According to Modern Healthcare, both want to fix the system that is bankrupting the nation. Ryan wants to “maintain a world class system built on innovation and excellence,” while Shumlin wants that single payer system to eliminate waste, administrative overhead and insurance company profits. It is Shumlin’s contention that enacting all of the Tea Party cuts and taxing the wealthy would still lead to the same federal budget challenges in the trillions of dollars that we face now.

Ryan wants to cut $750 billion in Medicare spending by making the allocation a block grant. People like Rose Ann DeMoro, executive director of the AFL-CIO- affiliated National Nurses United labor union say, “The market isn’t magic and it doesn’t trickle down…the Paul Ryans of the world don’t want a society.  They want individuals and corporations to make ungodly amounts of money.”

And so the debate continues. There is no magic elixir that will fix this without huge disagreements and turf battles.  As the Obama legislation began to unfold, the initial reaction from many within his own party was that his administration had “sold out” to Big Pharma and numerous other lobbies, and, as the Republican plan continued to be unveiled, the response was similar to DeMoro’s, because it was so heavily skewed toward big business and the free market, while providing only marginal assistance for the underserved of this nation.

UPMC vs. Highmark (Illustration by Ted Crow, Post-Gazette) - Nick Jacobs, FACHEIronically, as I look out my window and then drive a block from my apartment in Pittsburgh, I see another new “colony” of homeless people living under the bridge, and as I round the corner under Route 279N, there is a virtual apartment building under that road comprised of sheets and blankets hung to create separate partitions for the individual homeless people to live. At the next light leading to the North Side, a 30ish young mom begs on the corner for money for her kids, and two blocks past her is a homeless Veteran asking for money as well.

In the midst of all of this, the $9 billion UPMC battle with the nearly $4 billion Highmark juggernaut continues over an insurance company owning a hospital, and a hospital owning an insurance company.  Surely, in the richest country in the world, there are answers to these challenges that do not bankrupt the pharmaceutical or insurance companies, do not make our physicians second class citizens, and do not close two thousand small and medium sized hospitals while still providing care for everyone.

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Excerpts and Opinions on “What Makes a Hospital Great?”

March 17th, 2011

Dr. Pauline W. Chen’s March 17th New York Times article answers the question, “What Makes a Hospital Great?” In this article, Dr. Chen finds:

Dr. Pauline W. Chen - surgeon & New York Times contributor - Nick Jacobs, FACHE

Pauline W. Chen, MD | Blog: paulinechen.typepad.com

“Hospitals have long vied for the greatest clinical reputation. Recent efforts to increase public accountability by publishing hospital results have added a statistical dimension to this battle of the health care titans. Information from most hospitals on mortality rates, readmissions and patient satisfaction is readily available on the Internet. A quick click of the green ‘compare’ button on the ‘Hospital Compare’ Web site operated by the Department of Health and Human Services gives any potential patient, or competitor, side-by-side lists of statistics from rival institutions that leaves little to the imagination. The upside of such transparency is that hospitals all over the country are eager to improve their patient outcomes. The downside is that no one really knows how.”

I’ve written often about the failed promise of technology alone, and this is reaffirmed in Dr. Chen’s findings:

“…hospitals have made huge investments in the latest and greatest in clinical care — efficient electronic medical records systems, ‘superstar’ physicians and world-class rehabilitation services. Nonetheless, large discrepancies persist between the highest and lowest-performing institutions, even with one of the starkest of the available statistics: patient deaths from heart attacks.”

As she asks why this is,  the answers have become relatively clear from a study that was released in the Annals of Internal Medicine this very week. This research indicated that it was not the expensive equipment, the evidence-based protocols, or the beautiful Ritz Carlton-like buildings. It was, instead, the culture of the organization.

Hosptials in both the top and bottom five  percent in heart attack mortality rates were queried by the study team. One hundred fifty interviews with administrators, doctors and other health care workers found that the key to good (or bad) care was “a cohesive organizational vision that focused on communication and support of all efforts to improve care.”

Elizabeth H. Bradley, Phd, Yale School of Public Health

Elizabeth H. Bradley, Phd, Yale Global Health Leadership Institute

“It’s how people communicate, the level of support and the organizational culture that trump any single intervention or any single strategy that hospitals frequently adopt,” said Elizabeth H. Bradley, Senior Author and Faculty Director of Yale University’s Global Health Leadership Institute.

So, it wasn’t the affiliation with an academic medical center, whether patients were wealthy or indigent, bed size, or rural vs. urban settings that mattered in hospital mortality rates. Rather, it was the way that patient care issues were challenged that made the difference. The physicians and leaders at top-performing hospitals aggressively go after errors. They acknowledge them, and do not criticize each other. Instead, they work together to identify the sources of problems, and to fix them.

One of the most telling findings in this study was that relationships inside the hospital are primary, and the physicians and staff must be committed to making things work. Dr. Bradley said. “It isn’t expensive and it isn’t rocket science, but it requires a real commitment from everyone.”

So, the next time that you select a hospital, look up its statistics, and I guarantee you that you will be surprised. When it comes to outcomes, to nurturing or even competent care, the biggest is not always the best.

Learn More:

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Thanksgiving and CHANGE…

November 21st, 2009

One of the sometimes-challenging realities of Thanksgiving is that it forces us to look into the microscope of our personal time here on earth and acknowledge the change that will always be a part of our humanity.  This week I received a phone call that should never have been necessary “in my lifetime.”  One of my former employees passed away. For those of you who have some knowledge of my past, you might scratch your head in confusion regarding my deep consternation and pain from the loss of one person, because there were literally thousands of employees with whom I have worked over the years. But, for the others of you who know me well, you will clearly understand.

When I became the president of my former hospital, the waves of change had touched on it shores only briefly as it had attempted to avoid being consumed by neighboring health systems.  Because of this challenge of competition, we were given the authority to “try some new things” to attempt to preserve the facility as a community hospital.  To say that the road ahead was laced with hazards would be a serious understatement, but we did  navigate those sometimes treacherous waters successfully.

Carolyn "Winnie" Horner (1961-2009)As my tenure began in this difficult environment, a few people stepped forward who “got it.”  Winnie Horner was one of those people.  She “got it” from our first presentation about our dreams and plans.  Winnie was literally one of a handful of people who was willing to put herself out there to help the hospital establish new dreams, new ideals, new goals, and new caring philosophies.

Because a concept seems easier to embrace if it can be identified with others, we became a Planetree Hospital, the third in the United States and the first in Pennsylvania.  It was our goal to become a Healing Hospital.  It helped to jump start us into a new world of compassionate, healing, loving care that literally gave new life to the organization and helped it to remain not only open but also to succeed in ways that could never have been imagined.

Winnie not only “got on board,” for a long time she became the engineer of that train.  Her passion, her kind ways, her belief in spirituality, her amazing  voice, and her commitment to change was always obvious and appreciated.  She was a leader, a champion, the Joan of Arc of this effort, and I loved her for this.

Unfortunately, she will not get to read this because, at 48 years of age, she died this week.  Unbeknownst to her, she had been working with pneumonia, but, like Winnie always did, she kept giving of herself.  Who would have ever thought that it would have had this ending, and her three beautiful children are now without their mom this Thanksgiving.

So today, I write to you, Winnie.  You were a very important part of the soul of Windber Medical Center, and your presence will always be felt, but your absence will be felt even more deeply.

For me, Thanksgiving has always been a time of change, starting at a very young age as grandparents, uncles, aunts, and parents passed on.  The empty chairs at the table were always indicative of our own mortality, and the loss of those we love, be it permanent or just because of the sometimes-messy circumstances that are a part of living,  is a reality that we all must deal with throughout our time here on Earth.

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It’s ironic that, as commercial as our country has become, the tradition of Thanksgiving has remained virtually untouched in the essence of its meaning.  If you are alone for Thanksgiving, or with a cast of dozens, take a moment to reflect upon your life and your gifts.  Understand that nothing is permanent, and that, like Winnie Horner, we all have a chance to make a difference in thousands of lives, a positive, forever difference.

This year, Winnie and her passionate partners were able to achieve something that has only happened a handful of times in the world.  Through their work, Windber became a Planetree Designated Hospital, a model of care in the Planetree philosophy, my final Windber dream.  Thank you, Winnie, and if any of you don’t believe that you can make a difference, a real difference, take a page out of “Winnie’s Book.”  She was one of the best.

Planetree banner

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Planetree or Bust!

October 4th, 2009

Those who have worked with me know that I have been unequivocally one of the most loyal supporters of the Planetree Philosophy of care in the world.

My former place of employment was the third Planetree hospital in the country, after Planetree’s headquarters moved to Griffin (Derby, CT.)  We were the first Planetree hospital in Pennsylvania, and that hospital, Windber Medical Center, is now one of the top ten Planetree-designated sites internationally.  After having served on the Board of Directors of Planetree for nearly eight years, having written literally dozens of blog posts and articles about Planetree,  having taught numerous online seminars for them, contributed a chapter to their latest book, and served on the Planetree Speaker’s Bureau for half a dozen years, I’m back once again with a presentation this Tuesday at the Planetree 2009 conference.  It’s called: Take Care of Your Employees and They Will Take Care of Your Patients.

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Although I was encouraged to retire from the board in order to give newer members their opportunity to participate, and am no longer a part of the Speaker’s Bureau, with no formal ties to the organization anymore, I want to assure you that my experience, passion, and commitment to humanizing healthcare, transparency, creating a nurturing environment for patients and their families could not be stronger.

Since my transition from formally running hospitals full time,  I have immersed myself deeply into the world of  helping hospitals through my consulting practice to achieve the patient, employee, and family satisfaction ratings that ensure top scores in HCHAPS which, in turn, will result in increased business, increased revenue, and increased growth for any organization.

Nick Jacobs, FACHE
Nick Jacobs, FACHE

I am including one of my lastest articles on Integrative Health written for Hospital News.  Remember, if I can help, just call, e-mail or or comment:

Integrative Medicine

Massage, Flower Essences, Spiritual Healing, Drumming, Reiki, Acupuncture, Music, Aroma, Humor, Pet, and Art Therapy; all of these healing practices were formerly referred to as Alternative or Complementary Medicine.  They deserve, however, to be referred to as Integrative Medicine. Because, when we integrate these various disciplines with other contemporary healing methodologies, the results can be amazing.

As a hospital CEO, it brought me great satisfaction to introduce all of these treatments to the healing environment of the hospital.  Many times they came amid intense resistance from both the medical staff, and some members of leadership.  In fact, after nearly 10 years of offering comprehensive exposure to Integrative Medicine, we still had a smattering of nonbelievers.  The only thing questionable about these therapies for a healthcare administrator is that the typical insurance companies don’t cover the costs of all of them and cash payments come into play.

The number of patients coming to our facility had tripled through the emergency room alone as did the overall budget of the entire organization during that time period.  Those “Forest for the Trees” practical leaders still could not bring themselves to give credit to one of the major contributing factors involved in that surge of the hospital’s popularity.  Yes, of course, we also encouraged 24 hour, seven day a week visiting, had guest beds in many patient’s rooms, and served meals to the families on the medical floor where their loved one was a patient. Did all of this combine to the create a healing environment?  Of course it did, but Integrative Medicine was the heart and soul of the difference.

Their skepticism seems to fit into the cycle of questioning the validity of wellness and prevention, two comprehensively established methodologies for improving general health and well-being, proven over centuries of unofficial clinical trials.  Wellness and Prevention works, but because the insurance companies have not yet fully embraced these philosophies, then some still say that they are not valid.  Treating sickness can be as comprehensive as ensuring wellness.  For whatever reason, some of our medical and administrative leaders often confuse reimbursements with healing, and forget to add new patients and additional income from related disciplines like PT and OT to the equation.

As a nonmedical, nonscientist, it was easy for me to understand why the various integrative arts worked so well for our patients and their families.  From the old song, “All You Need is Love,” you could easily enjoy the looks on the faces of those patients and family members who used these treatments to receive sorely needed relief from whatever pain or loneliness they were experiencing.  It doesn’t matter if you’re eighty minutes or eighty years old; touch, nurturing, and love all remain critical in our lives.  Have you seen the statistics on how much better people do with pets than without, or how many babies died in orphanages due to the “failure to thrive?”

None of these ancient arts were created because the scientific method produced FDA approved results in trials of 200,000 or more.  They evolved into centuries old healing arts because they provided relief and help in a time when leeches, bleedings, and a lack of hand washing were the accepted medical treatments.  The tribal shaman, medicine man, healers, and other spiritual leaders all knew what the subtle and not so subtle impact of their work meant to their fellow human beings.

We have casually observed the use of these healing modalities on patients who have experienced restored feelings to otherwise numb feet.

We have seen them relieved from debilitating back pain, healed from hopeless wounds, saved from surgeries due to the opening of blocked intestines through acupuncture.  We have observed psychological breakthroughs from drumming that had never been reached by traditional therapy.  Truthfully, I didn’t care exactly what made our patients better, just that they were better, and the results were dramatic, with an infection rate of 1% or less, a 3.4 day length of stay, a low readmission rate, and the lowest mortality rate for adjusted morbidity in the region.

Remember, “All You Need is Love.”

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On Data Breaches

September 4th, 2009

About two years ago, I had a call from my local bank asking if I had purchased a washer and dryer… in Barcelona, Spain. Somewhere, someone had gained access to my credit card number, and used it illegally for that  purchase overseas.

It was not too long after that that another bank informed me that my card had to be canceled because of a data breach at a national chain store where I had purchased some clothing. (I have since come to learn that this data breach has already cost their parent company over $220M.) Then, a few weeks later, another card had to be canceled and re-registered.  Finally, about three months after that, restrictions were placed on still another set of cards due to similar, but entirely unrelated breaches. Three cards, three banks, multiple breaches …and my wallet was still firmly tucked in my back pocket.

Joe Carberry / David Chamberlin / FORBES magazine - data breaches - NickJacobs.org
In a recent article in Forbes Magazine, the facts and figures of this new, growing phenomena were outlined statistically so as to begin to bring some sense to the table regarding what we are facing.  The authors, Joe Carberry and David J. Chamberlin state that “Only 36% of C-level executives are confident their organizations will not suffer data breaches in the  next 12 months.”

As healthcare gears up to go completely electronic, we must remember that there are, for all practical purposes, entire countries dedicating serious efforts to breach the United States data banks.  Hackers are no longer  identified as stereotypical, 98 pound computer savants.  Many of them are professional criminals and terrorists.  As a former CEO, I always had to be cognizant of the risk, then do whatever we felt we could afford to do to help mitigate that risk.  Rarely, however, have I seen any type of comprehensive commitment to a comprehensive, multi-faceted approach to this effort.

computer security1_220The laws that address data breaches involve not only civil but also criminal penalties, and the individual laws of various states are most times very different.  It doesn’t matter if your business is located in only one state. What matters is where your customers are from, and if they are a diverse group, you must comply with each
state law regulating breach notification.

SunStone Consulting, LLC, and Immersion Ltd., through their InfoLaunch suite of products, are positioned to assist you to prepare for any type of breach.  As Carberry and Chamberlin state, preparation must involve not only legal, but also communications, the C -suite, and risk management.  They further recommend the following steps:

1. Be prepared

2. Move quickly

3. Take action, and

4. Be responsible.

The  professional reputation damage that could be encountered by the hospital or physician practice that is not responsible, not prepared, slow moving, and not action-oriented can be devastating.

Are you prepared?

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